MEDICARE: VICTORIA KATHERINE WHITMIRE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	63964	TX

General Provider Information

NPI Number	:	1619675857
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VICTORIA KATHERINE WHITMIRE

Provider Business Mailing Address
First Line	:	PO BOX 748465
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30374-8465
Country	:	US
Telephone Number	:	855-284-7483
Fax Number	:	617-807-0958

Provider Business Practice Location Address
First Line	:	3721 S STONEBRIDGE DR UNIT 1402
Second Line	:
City	:	MCKINNEY
State	:	TX
Zip	:	75070-0236
Country	:	US
Telephone Number	:	855-284-7483
Fax Number	:	617-807-0958

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/17/2023
Last Update Date	:	02/17/2023

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